Massive Subchorial Thrombohaematoma (Breus' Mole)

Abstract

Summary Ten placentae with massive subchorionic thrombohaematomas are reported. This lesion, which is composed of maternal clotted blood, separates the chorionic plate of the placenta from the villous chorion and is traversed by the main cotyledonary branches of the fetal circulation. In some instances it dissects into the layers of the chorionic plate. In anatomical terms it is identical to the lesion which has been described in early pregnancy under the title of Breus’ mole. Previous reports suggested that the lesion was confined to early pregnancies and was a consequence of fetal death. In our series all ten placentae were from pregnancies of at least 25 weeks' maturity and six were more than 30 weeks. Seven infants were liveborn and three survived the neonatal period. Differential diagnosis is discussed along with aetiology, which is still obscure although earlier theories implicating fetal death may be discounted.

A Case of Massive Subchorionic Thrombohematoma Diagnosed by Ultrasonography and Magnetic Resonance Imaging

“…Massive subchorionic thrombohematoma was first thought to be a consequence of fetal death [2], but from the following reports it was established to be a cause of the fetal death [1]. It is accompanied by IUGR, oligohydramnios or fetal distress due to insufficiency of fetal-placental circulation [5,6].…”

“…The massive subchorionic thrombohematoma is defined as a large size of maternal blood clot that separates the chorionic plate from the villous chorion [1]. Although massive subchorionic thrombohematoma is less frequent compared with placental infarction or chorioangioma [1], it causes severe IUGR due to the cirulatory disturbance of placenta [2].…”

A Rare Form of Abruptio Placenta and Clinical Presentation in a Preterm Labor Case: Breus’ Mole

“…Breus described a casual relationship between massive thrombohematomas at the preplacental site and fetal demise in 1892. However, Shanklin and Scottt [4] collected and described the results of a study with 19,000 placentas, detected ten new cases with Breus' mole in among whom seven infants were liveborn and some even survived. Fetal demise and subsequent separation of placenta, bleeding, clotting and hematoma formation could not explain the underlying pathogenesis in all cases of Breus's mole such as in our case with live-born infant.…”

“…Since the original description by Breus in 1892, clinicians believed that massive subchorionic hematomas beneath the chorionic surface, projecting focally into the amniotic cavity was the result of fetal death [3] . However, Breus' moles in placentas from liveborn infants were reported in the literature [4,5] .…”

Carneous mole in a depressed patient: a diagnostic dilemma

“…Their lesions were composed of maternal clotted blood that separates chorionic plate of placenta from villous chorion and traversed the main cotyledon branches of foetal circulation. 10 Occasionally, the patient complaints of ammenorrhea and had typical signs and symptoms of pregnancy or passage of brown or dark colored vaginal discharge. If, carneous mole is retained for longer duration, all signs and symptoms of pregnancy regresses and even biochemical tests i.e., urinary pregnancy test (UPT) become negative.…”